Massachusetts Medical Society: Hampshire District and The Rollin M. Johnson, M.D. Scholarship

Hampshire District and The Rollin M. Johnson, M.D. Scholarship

Medical Student Application for Educational Grant

The Hampshire District Medical Society of the Massachusetts Medical Society is pleased to announce The Rollin M. Johnson, MD, Scholarship Award is available in the amount of $2,000. The following criteria must be met for an individual to be considered for the grant. 

The following criteria must be met for an individual to be considered for the grant:

  • Must live or have lived in Western Massachusetts for at least five consecutive years.
  • A letter of matriculation must be submitted from the medical school the individual is attending.
  • A copy of a letter of recommendation from the undergraduate school to the medical school must be submitted.

Your application is not considered complete until you email to csalas@mms.org a PDF of any other supportive documentation requirements that are listed above.

Application Deadline: April 30

Required Fields are marked with an * 

Applicant Information:

First Name*:
   
Middle Name*:
   
Last Name*:
   
Mailing Address*:  
   
Legal Residence*:  
   
Address (if different)
in Western Massachusetts:
 
   
Phone Number:*
   
Email Address*:

Education:

Undergraduate School*:
 (Full Name and Location)
 
   
Undergraduate School
 Graduation Year*:
   
Medical School*:  
   
Medical School Graduation Year*:
   
Graduate School
(other than Medical School):
 
   
Graduate School Graduation Year:


Personal Statement: 

A personal statement of 1,000 characters or less as to why you feel you should receive this award.* 

       


Electronic Signature:

I acknowledge that my digital signature below shall have the same force and effect as a written signature and intend to be bound by it, and I certify that all of the information I’ve provided is true to the best of my knowledge.

Electronic Signature (Please Type Full Name)*:
   
Date*:

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